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    <title>光大分期</title>
</head>
<body>
    <div class="container">
        <div class="row">
            <a href="index.html" class="btn btn-default pull-left">返回首页</a>
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        <div class="help-block"></div>
        <div class="row">
            <h1 class="text-center"><strong>光大减免模板</strong></h1>
        </div>
        <div class="row">
            <h1>
                债务人：<input type="text" id="aa" />
            </h1>
        </div>


        <div class="row">
            <h2>
                截止<input type="number" id="bb" style="width:120px" />年<input type="number" id="cc" style="width:120px" />月<input type="number" id="dd" style="width:120px" />日，欠款总额<input type="number" id="ee" style="width:120px" />元，其中本金<input type="number" id="ff" style="width:120px" />元、违约金<input type="number" id="gg" style="width:120px" />元、超限费<input type="number" id="hh" style="width:120px" />元、服务费<input type="number" id="ii" style="width:120px" />元、利息<input type="number" id="jj" style="width:120px" />元、分期利息<input type="number" id="kk" style="width:120px" />元。
            </h2>
        </div>

        <div class="row">
            <h2>
                经协商还款（人民币/美元）<input type="number" id="ll" style="width:120px" />元已还清本金，还款期间新增息费<input type="number" id="mm" style="width:120px" />元，恳请贵行考虑实际情况减免剩余息费<input type="number" id="nn" style="width:120px" />元。
            </h2>
        </div>


        <div class="row">
            <form class="form-inline">
                <div class="form-group">
                    <label>请选择收件人</label>
                    <select class="form-control" id="rr">
                        <option></option>
                    </select>
                </div>
                <button type="button" id="zz" class="btn btn-primary">点击发送</button>
            </form>

        </div>
    </div>


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